Total gastrectomy improves glucose metabolism on gastric cancer patients: A nationwide population-based study

Background Total gastrectomy (TG) is potentially curative for upper gastric cancer (GC) and includes both stomach removal and enteral bypass reconstruction. Therefore, similar to bariatric surgery, TG may contribute to a change in glucose metabolism. Objectives The aim of this population-based study was to determine if there are any changes in glucose metabolism after TG in patients with GC. Setting Nationwide population database. Methods We conducted a nationwide cohort study using data from Taiwan's National Health Insurance Research Database collected between 2000 and 2011. Two cohorts were sampled for further analysis of changes in glucose metabolism after TG, including a diabetes group and non-diabetes group. Results A total of 8593 patients with TG were identified. Of the 579 patients with diabetes with GC, 178 (30.7%) achieved diabetes remission after TG. On Cox multivariate analysis, patients aged 50 to 64 years (odds ratio [OR],.48; 95% confidence interval [CI],.31-.75; P<.01) and those who used insulin (OR,.31; 95% CI,.19-.51; P<.01) had lower rates of diabetes remission, whereas liver cirrhosis patients had higher rates of diabetes remission (OR, 1.77; 95% CI, 1.16-2.69; P<.01). On the other hand, patients without diabetes but who had GC (n = 1565) had lower rates of newly diagnosed diabetes after TG compared with the general population as assessed by control-to-case analysis (OR,.56; 95% CI,.47-.66; P<.01). Conclusion Our data showed that TG contributes to improved glucose metabolism in patients with GC. ? 2016 American Society for Bariatric Surgery.